Transcatheter closure of paravalvular regurgitation: Case-based learning

Abstract

Current class IIa indications for percutaneous interventions for closure of paravalvular leaks includes patients with prosthetic heart valves and intractable hemolysis or NYHA class III/IV HF who are at high risk for surgery and have anatomic features suitable for catheter-based therapy when performed in centers with expertise in the procedure. Recent reports show high procedural success, defined typically as =1+ residual regurgitation. Improvement in heart failure symptoms is usually limited to patients with no or mild residual regurgitation following closure. Patients with hemolytic anemia however, often fail to improve despite successful closure with persistent or worsening hemolysis reported in up to 33 % of patients and new-onset hemolysis in 10 %. Transesophageal imaging is key to pre-procedural planning and involves a determination of: (a) the number and location of defects; (b) the shape and exact size of each defect; (c) the distance and orientation of the defect to the sewing ring or prosthesis. Intra-procedural imaging is essential for guidance of wire/catheter placement and an assessment of complications such as cardiac perforation, prosthetic valve dysfunction or device embolization.